Are prisons turning into nursing homes?

The number of lifers in U.S. prisons has tripled in the last 20 years, turning the penal system into a de facto nursing home for criminals—and you’re paying for their medical care. Is there a better solution?

  • Photograph: Peter Thompson/AP

    William Heirens, who died in Dixon Correctional Center last March after serving nearly 66 years for three notorious North Side killings, stands in the yard of the prison in 2002.

  • Photograph: Peter Hoffman

    Dixon Correctional Center inmate Thomas Odle admits to killing five family members in Mount Vernon in 1985, when he was 18. He is serving life in prison and is not eligible
    for parole.

  • Photograph: Peter Hoffman

    Dixon Correctional Center in Dixon, Illinois

Wilbert Rideau began serving a sentence for murder in Louisiana’s Angola Prison in 1961, when he was 19 years old. He met “very few” old men.


“Back then, they didn’t let people grow old in prison,” says Rideau, who became an acclaimed prison journalist. Freed in 2005, he recently released an autobiography, In the Place of Justice. “Everybody had a parole date or a pardon date. The governing philosophy of the penal system was they sent ’em in there to teach ’em a lesson. They believed in second chances.”


The early 1960s, though, were an extraordinarily peaceful time in America. Later in the decade, ghettos erupted in riots, and murders increased four- and fivefold in many cities, including Chicago, causing a tough-on-crime backlash among courts and prosecutors. Illinois abolished parole for all crimes committed after 1978, replacing it with determinate sentencing. That means a lifer can be released only if he receives clemency, a shortened sentence that can be granted solely by the governor.


The War on Drugs of the 1980s expanded the prison population even more, while forcing states to issue longer sentences for drug and violent offenses as a condition of receiving federal law-enforcement funds. Then, in 1988, Massachusetts Gov. Michael Dukakis lost the presidential election in a landslide after Republicans ran an ad about William Horton, a first-degree murderer who raped a woman while out of prison on a weekend furlough issued during Dukakis’s second term. After that, no governor wanted to risk letting a killer go free.


Eliminating parole was popular with both liberals, who thought the parole board discriminated against blacks, and conservatives, who wanted longer sentences. But the system that replaced it—in which life means you’re only leaving prison in a hearse—has created a class of superannuated inmates.


If you’re a prisoner who’s 50 or older, the Illinois Department of Corrections classifies you as elderly. You probably have diabetes or high blood pressure from eating starchy foods and undergoing the stress of confinement; prisoners are, physiologically, about 11 years older than their contemporaries in the free world, according to a study in the Journal of Correctional Health Care. Illinois imprisons nearly 7,000 men and women over 50—approximately 14 percent of the state’s prison population. The Illinois Department of Corrections spends about $122 million a year on health care—10 percent of its budget.


“It is unclear how Illinois will pay for the housing, treatment and medical care of this growing elderly inmate population,” says the study “Unasked Questions, Unintended Consequences,” a 2012 report on the Illinois prison health-care system by the John Howard Association, a prison reform organization. “Estimates place the average cost of incarcerating an elderly inmate between $60,000 and $70,000 per year, compared to the $27,000 a year it costs on average to house a general population inmate. Because the federal government does not pay for state inmates’ medical care, these costs are borne almost entirely by Illinois taxpayers.”


And “you’re never just paying for medical care,” adds John Maki, executive director of the John Howard Association. For one thing, when prisoners are transported to hospitals for specialized care, they are accompanied by guards who may be paid overtime for the trips.


One solution backed by the JHA: If sickly prisoners were released into nursing homes, their health care would be less expensive—and would be paid for by Medicare, which is funded mainly by the federal government.


But the question of how to deal with murderers in their dotage requires the state to reconcile two conflicting desires among the public: paying lower taxes, and punishing criminals to the fullest extent of the law. In 2011, Louisiana passed a law making it easier for nonviolent, non–sex offenders over 60 to receive parole. When a similar bill came before the Illinois House of Representatives in 2009—it aimed to create a “sentence modification” program that would allow the Prison Review Board to release inmates (both violent and nonviolent offenders) over 50 if they had served 25 years—it was defeated 83–32.


“Thousands of victims across the state have counted on the system to provide integrity that if we’re going to lock [up] somebody for 60 years, then they’re going to serve 60 years,” Rep. Dennis Reboletti, an Elmhurst Republican, said during a debate before the vote. For public-safety reasons, “I think we need to keep convicted murderers, cop killers and sex offenders locked up.”